Healthcare Provider Details

I. General information

NPI: 1205740982
Provider Name (Legal Business Name): MS. MYESHA KINNARD MYESHA KINNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 FOXTON LN
ANTIOCH TN
37013-4641
US

IV. Provider business mailing address

1230 FOXTON LN
ANTIOCH TN
37013-4641
US

V. Phone/Fax

Practice location:
  • Phone: 615-981-0504
  • Fax:
Mailing address:
  • Phone: 615-981-0504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: